Florida Senate - 2024 SB 488 By Senator Polsky 30-01023-24 2024488__ Page 1 of 11 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to Medicaid coverage for prescribed 2 foods for disease treatment and prevention; creating 3 s. 409.90203, F.S.; defining terms; requiring the 4 Agency for Health Care Administration, in conjunction 5 with the Department of Health, to establish the Food 6 is Medicine Pilot Program to provide Medicaid coverage 7 for purchases and deliveries of prescribed health-8 promoting foods under certain circumstances; requiring 9 the agency, in conjunction with the department, to 10 seek federal approval and waivers for the pilot 11 program; requiring the federal waiver application to 12 seek matching funds; requiring referrals of pilot 13 program patients to certain federal and federally 14 funded programs; requiring allocation of a portion of 15 the pilot program implementation budget to a specified 16 organization for the establishment of a specified 17 center; providing operation requirements for the 18 center; providing reporting requirements; requiring 19 the agency, in conjunction with the department, to 20 adopt rules; providing requirements for the rules; 21 providing an effective date. 22 23 Be It Enacted by the Legislature of the State of Florida: 24 25

Section

Section 409.90203, Florida Statutes, is created 26 to read: 27 409.90203 Food is Medicine Pilot Program; Medicaid coverage 28 for pilot program; federal approval and waivers; Florida Food is 29

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 2 of 11 CODING: Words stricken are deletions; words underlined are additions. Medicine Center of Excellence.— 30

(1) As used in this section, the term: 31 (a) “Center,” unless the context clearly indicates 32 otherwise, means the Florida Food is Medicine Center of 33 Excellence established under this

section and operated by the 34 Florida Health and Nutrition Coalition. 35 (b) “Food is Medicine” means food-based interventions and 36 services that include medically precise nutrition, medically 37 tailored meals, or produce prescriptions, with nutrition 38 education and specific supports provided to a person with a 39 specific diet-related disease or chronic condition to 40 effectively support behavioral change related to the consumption 41 of healthful food and physical activity conducive to health and 42 well-being while improving health outcomes and achieving health 43 care cost savings through the control and reversal of the 44 disease or condition and the prevention of further disease or 45 condition complications. 46 (c) “Medically precise nutrition” means a medical nutrition 47 groceries program provided to a Medicaid recipient through a 48 prescription or referral from a physician licensed under

chapter 49 458 or

chapter 459, or through a referral from a clinic or 50 hospital staff member, a licensed clinical social worker, a 51 registered dietitian/nutritionist, or a health plan, for fresh 52 and health-promoting groceries purchased and distributed with 53 nutrition education and specific supports to produce positive 54 health outcomes for a specific diet-related disease or chronic 55 condition. 56 1. The medical nutrition groceries program must be in a 57 protocol standard selected, reviewed, and approved by a 58

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 3 of 11 CODING: Words stricken are deletions; words underlined are additions. registered dietitian or registered dietitian/nutritionist 59 licensed under s. 468.513 as part of a 6-month intervention 60 treatment program that follows the model of healthful food 61 prescription programs supported by research conducted by the 62 Gerald J. and Dorothy R.

Friedman School of Nutrition Science 63 and Policy at Tufts University and implemented by the nonprofit 64 organization Living Hungry and that is certified by the Florida 65 Food is Medicine Center of Excellence to meet the quality and 66 cultural standards and the health standards for the specific 67 disease or chronic condition. 68 2.

The medical nutrition groceries program may include 69 supports through behavioral health counseling, Food is Medicine 70 functional medicine classes, anatomy of disease classes, cooking 71 classes, gym or exercise classes, weekly menus and shopping 72 lists, grocery store tours, and motivational habit change 73 supports such as peer mentoring and health coaching in a 74 protocol designed for a Medicaid recipient with a specific diet-75 related disease or chronic condition to effectively control or 76 reverse the disease or condition effects and prevent further 77 disease or condition complications. 78 3.

The health-promoting groceries under the medical 79 nutrition groceries program may be: 80 a. Picked up at the health plan facility or clinic or at an 81 event organized by a community-based organization or by an 82 entity under contract with the program, such as a grocery store; 83 or 84 b. Delivered to the residence of the Medicaid recipient by 85 the program or by an entity under contract with the program. 86 4. The medical nutrition groceries program: 87

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 4 of 11 CODING: Words stricken are deletions; words underlined are additions. a. May include healthful recipes and healthfully prepared 88 ingredients, herbs, spices, and sauces. 89 b. May include at-home laboratory tests, supplements, 90 monitoring supplies, and telehealth components. 91 c. Must include nutrition education. 92 d.

Must include a program evaluation to report health 93 outcomes, including, but not limited to, biomarkers, nutrition 94 security assessments, and healthful eating and behavior change 95 surveys before and after the use of the program to evaluate the 96 program’s effectiveness. 97 (d) “Medically tailored meals” means a medical meal plan 98 program, provided to a Medicaid recipient through a prescription 99 or referral from a physician licensed under

chapter 458 or 100

chapter 459, or through a referral from a clinic or hospital 101 staff member, a licensed clinical social worker, a registered 102 dietitian or registered dietitian/nutritionist, or a health 103 plan, for meals purchased and distributed with nutrition 104 education and support to produce positive health outcomes for a 105 person with a specific diet-related disease or chronic 106 condition.

The medical meal plan program must be designed, 107 reviewed, and approved by a registered dietitian or registered 108 dietitian/nutritionist licensed under s. 468.513 to reflect 109 appropriate medical nutrition therapy based on evidence-based 110 practice guidelines for the specific diet-related disease or 111 chronic condition that requires the prescription or referral. 112 1.

The meals under the medical meal plan program must be 113 fully prepared by a Medicaid provider or by a person, entity, or 114 community-based organization under contract with a Medicaid 115 managed care organization or with a Medicaid provider and must 116

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 5 of 11 CODING: Words stricken are deletions; words underlined are additions. be certified by the Florida Food is Medicine Center of 117 Excellence to meet the quality and cultural standards and health 118 standards for the specific disease or chronic condition. The 119 meals may be: 120 a. Picked up at the health plan facility or clinic or at an 121 event organized by a community-based organization or by an 122 entity under contract with the program, such as a restaurant or 123 grocery store; or 124 b.

Delivered to the residence of the Medicaid recipient by 125 the program or by an entity under contract with the program. 126 2. The medical meal plan program: 127 a. May include healthful recipes and healthfully prepared 128 ingredients, herbs, spices, and sauces. 129 b. May include at-home laboratory tests, supplements, 130 monitoring supplies, and telehealth components. 131 c. Must include nutrition education. 132 d.

Must include a program evaluation to report health 133 outcomes, including, but not limited to, biomarkers, nutrition 134 security assessments, and healthful eating and behavior change 135 surveys before and after the use of the program to evaluate the 136 program’s effectiveness. 137 (e) “Nutrition education” means a validated course and 138 series of nutrition education classes in a 6-month intervention 139 program such as the Expanded Food and Nutrition Education 140 Program, a research-based nutrition education program funded by 141 the United States Department of Agriculture which teaches 142 participants to grocery shop and plan and cook nutritious meals 143 through lessons given by in-language, in-culture 144 paraprofessionals and other educators from the Extension Family 145

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 6 of 11 CODING: Words stricken are deletions; words underlined are additions. and Consumer Sciences programs of the University of Florida 146 Institute of Food and Agricultural Sciences (IFAS), with sites 147 in multiple counties across the state.

The term also includes 148 surveys before and after the classes to measure habit changes 149 and evaluate applications of nutrition education among Florida 150 residents, especially among populations that endure a 151 disproportionate share of food insecurity. 152 (f) “Pilot program” means the Food is Medicine Pilot 153 Program established in this section. 154 (g) “Produce prescription” means a program that is 155 provided, through a prescription or referral from a physician 156 licensed under

chapter 458 or

chapter 459, or through a referral 157 from a clinic or hospital staff member, a licensed clinical 158 social worker, a registered dietitian or registered 159 dietitian/nutritionist, or a health plan, to a Medicaid 160 recipient who has or is at risk of a specific diet-related 161 disease or chronic condition such as diabetes, coronary artery 162 disease, cancer, obesity, renal disease, celiac disease, asthma, 163 or dementia, to purchase produce at no cost or low cost using a 164 technology-enabled application such as About Fresh; a coupon; a 165 voucher; a debit card; a digital currency; or other means of 166 storing value to be redeemed for purchasing fresh or frozen 167 produce. 168 1.a.

The technology-enabled application, coupon, voucher, 169 debit card, digital currency, or other means of storing value 170 may be redeemed at a farm store, farm packing house, mobile 171 farmers’ market, market as defined in s. 414.456(1), or 172 community-based organization site; or 173 b. The produce may be delivered to the residence of the 174

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 7 of 11 CODING: Words stricken are deletions; words underlined are additions. Medicaid recipient or distributed through a market or store or 175 through a Medicaid provider or health plan facility or clinic. 176 2.

The program must be in a protocol standard selected, 177 reviewed, and approved by a registered dietitian/nutritionist 178 licensed under s. 468.513 as part of an intervention program 179 that may include medical nutritional therapy by a registered 180 dietitian/nutritionist, behavioral health counseling, Food is 181 Medicine functional medicine classes, anatomy of disease 182 classes, cooking classes, gym or exercise classes, weekly menus 183 and shopping lists, grocery store tours, and habit change 184 supports such as peer mentoring and health coaching designed for 185 a Medicaid recipient with a specific diet-related disease or 186 chronic condition to effectively control and reverse the disease 187 or condition effects and prevent disease or condition 188 complications.

The program: 189 a. May include healthful recipes and healthfully prepared 190 ingredients, herbs, spices, and sauces. 191 b. May include at-home laboratory tests, supplements, 192 monitoring supplies, and telehealth components. 193 c. Must include nutrition education. 194 d.

Must include a program evaluation to report health 195 outcomes, including, but not limited to, biomarkers, nutrition 196 security assessments, and healthful eating and behavior change 197 surveys before and after the use of the program to evaluate the 198 program’s effectiveness. 199 (h) “Program evaluation” means an annual evaluation of a 200 state Medicaid-funded program that uses medically precise 201 nutrition, medically tailored meals, or produce prescriptions to 202 assess fidelity of program implementation and overall program 203

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 8 of 11 CODING: Words stricken are deletions; words underlined are additions. effectiveness, as well as health biomarker outcomes, nutrition 204 intake, health equity, healthful habit adoption, and food 205 insecurity. The annual evaluation: 206 1. May either be funded by the agency and conducted by IFAS 207 Food is Medicine evaluators or be a component of the program’s 208 implementation budget. 209 2. Must be reported to the agency and the Legislature. 210

(2) By July 1, 2025, the agency, in conjunction with the 211 Department of Health, shall: 212 (

a) Establish the Food is Medicine Pilot Program to provide 213 Medicaid coverage for purchases and deliveries of prescribed 214 healthful foods in disease-specific protocols through programs 215 that use medically precise nutrition, medically tailored meals, 216 or produce prescriptions to meet the specific needs of Medicaid 217 recipients who have or are at risk of a specific diet-related 218 disease or chronic condition and who are high-need patients or 219 patients requiring high-cost patient care or having the highest 220 health care expenditures.

The pilot program shall serve to 221 establish the impact of healthful foods on health outcomes of 222 Medicaid recipients and the cost-effectiveness of food and 223 services provided under the program. 224 (

b) Seek: 225 1. The pilot program’s approval by the United States 226 Secretary of Health and Human Services under s. 1115 of the 227 Social Security Act, which gives the secretary the authority to 228 approve, for an initial 5-year period, experimental, pilot, or 229 demonstration projects that are likely to assist in promoting 230 the objectives of the Medicaid program. 231 2. Any federal waivers necessary for the implementation of 232

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 9 of 11 CODING: Words stricken are deletions; words underlined are additions. the pilot program, including any waivers necessary to obtain 233 federal finances to secure Title XIX matching funds for the 234 pilot program. The federal waiver application shall seek 235 Medicaid matching funds for all general revenue, family 236 contributions, and local contributions. 237 (

c) Require IFAS nutrition education providers or other 238 nutrition educators to refer pilot program patients to the 239 federal Supplemental Nutrition Assistance Program, the Temporary 240 Assistance for Needy Families program, and the Special 241 Supplemental Nutrition Program for Women, Infants, and Children 242 in order to meet the Centers for Medicare and Medicaid Services 243 financial directive for Medicaid waiver for the pilot program. 244 (

d) Provide a portion of the pilot program implementation 245 budget, not to exceed 15 percent of the overall funds expended 246 for the pilot program, to the Florida Health and Nutrition 247 Coalition, a nonprofit corporation and coalition of Food is 248 Medicine stakeholders in this state, to establish a network 249 model central hub formed using the national best practices of 250 the United States Department of Agriculture Gus Schumacher 251 Nutrition Incentive Program and the National Institutes of 252 Health. The central hub established by the coalition shall be 253 called the Florida Food is Medicine Center of Excellence. 254 (3)(

a) The Florida Health and Nutrition Coalition shall 255 operate the Florida Food is Medicine Center of Excellence as an 256 online, Florida-based research and expertise repository by 257 accumulating data in the following areas: 258 1. Research. 259 2. Provision of services and activities such as referrals, 260 food sourcing, and logistics. 261

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 10 of 11 CODING: Words stricken are deletions; words underlined are additions. 3. Community outreach and engagement. 262 4. Education and training. 263 5. Coverage for services such as billing and fulfillment of 264 patients’ needs. 265 6. Health disparities. 266 (

b) The center, in collaboration with IFAS Food is Medicine 267 evaluators, shall: 268 1. Inform program operators during the pilot program 269 implementation. 270 2. Disseminate findings throughout this state and 271 nationally through the center’s stakeholder network. 272 3. Include in-language and in-culture Food is Medicine 273 activities for Florida residents. 274 (

c) The center shall report its research literature, 275 validated program models, operational planning frameworks, 276 nutrition standards, and strategies and tactics for effective 277 program activities to the agency and the United States 278 Department of Agriculture, the National Institutes of Health, 279 and the Centers for Disease Control and Prevention. 280

(4) The agency, in collaboration with the center and IFAS, 281 shall file an annual compilation report with the Legislature on 282 the pilot program, any reduction in food insecurity, health 283 outcome improvements and savings from the enrolled high-need 284 patients and patients with high-cost patient care, and any 285 advances in health equity. 286

(5) The agency, in conjunction with the Department of 287 Health, shall adopt rules to implement and administer this 288 section, including, but not limited to, rules relating to: 289 (

a) The quality standard and quantity and the number of 290

Florida Senate - 2024 SB 488 30-01023-24 2024488__ Page 11 of 11 CODING: Words stricken are deletions; words underlined are additions. medically tailored meals delivered per week to a Medicaid 291 recipient. 292 (

b) The funds allowed per Medicaid recipient for medically 293 precise nutrition, medically tailored meals, and produce 294 prescriptions. 295 (

c) Notification to Medicaid providers and Medicaid 296 recipients of the availability of and requirements for medically 297 precise nutrition, medically tailored meals, and produce 298 prescriptions. 299 (

d) The funds and model for evaluations for IFAS Food is 300 Medicine evaluators. 301 (

e) The funds and model for the best-practices information 302 repository hub and stakeholder network at the Florida Food is 303 Medicine Center of Excellence. 304 (

f) Methodology for reimbursing Medicaid providers and 305 other managed care organizations and health plans for products, 306 events, services, classes, or activities provided under the 307 pilot program by the providers, organizations, and plans that 308 use medically precise nutrition, medically tailored meals, or 309 produce prescriptions. 310

Section 2. This act shall take effect July 1, 2024. 311